Indian Journal of Forensic Medicine & Toxicology, January-March 2022, Vol. 16, No.

1 1405

Risk Factors’ estimation of Non Communicable Diseases in

Al-Basrah Province/ Iraq During 2020-2021

Sadiq Abdul Ameer Rahmah1, Shrouk Abdulrazak Hassan Alibraheem2, Rajaa Ahmed Mahmoud3
1
M.Sc. Student Department Community Health Techniques, College of Health & Medical Tech/Basrah, South
Technical University, Iraq, 2D.R. Lect.Department Medical Laboratory Techniques, College of Health & Medical
Tech/Basrah, South Technical University, Iraq, 3D.R.lect. Department Community Medicine, Al- Zahraa College of
Medicine, University of Basrah, Iraq

Abstract
Background: Non communicable diseases such as cardiovascular disease, cancers, diabetes, and
respiratory diseases are the leading causes of morbidity and mortality worldwide. They share risk
factors such as unhealthy diet, physical inactivity, smoking, and harmful alcohol use. The share of these
risk factors raises the probability of developing non-communicable diseases. The aim of study to assess
non communicable diseases risk factors in Al-Basrah province during 2020-2021.

Methods: A cross sectional study was implemented among 250 respondents aged from 18 years and
above according to random sampling method. Data was collected according to face -face interviews
with those attended to different primary health care centers in Al-Basrah province from September
2020 to February 2021.

Results: The study found 134(53.6%) respondents suffering from at least one of selected non
communicable diseases due to higher increase in behavioral risk factors. The proportion of participants
with unhealthy diet was 211(84.4%) while for overall salt intake was 207 (82.8%). the prevalence of
a currently smoker was 60 (24%) among participants and higher in males than females while for a
currently alcohol consumption the prevalence was 1 (0. 4%).the prevalence of physical inactivity was
176 (70.4%) and this percentage higher among females. The prevalence of overweight and obesity
(BMI>25 kg/m2) was 35.6% and 38% and this proportion was higher among females than males.

Conclusion: Non communicable diseases risk factors were alarming increases among population of
Al-Basrah and this increase due to social transition and eating habits without any affective programs
for prevention of these risk factors and control of non-communicable diseases.

Keywords: Non communicable diseases, risk factors, Basrah.

Introduction or medical conditions that is not infectious and

cannot be passed from person to person. Currently
Non-communicable diseases (NCDs) are diseases
(NCDs) are the major cause of mortality and disease
burden worldwide, the four major types of (NCDs)
Corresponding author:
Shrouk Abdulrazak Hassan Alibraheem include: cardiovascular disease, cancer, diabetes,
and respiratory disease. (1)
altyye149@gmail.com; The causes of NCDs
shrouk.albraheem@stu.edu.iq are multifactorial; these diseases may arise from
1406 Indian Journal of Forensic Medicine & Toxicology, January-March 2022, Vol. 16, No. 1

a combination of underlying, non-modifiable and
modifiable risk factors. (2) Non-modifiable factors are
those over which a person has no influence, such as
age, gender, race, and genetic, Modifiable indicators
were those that can be modified by individuals, such as
behavior, socioeconomic, and cultural influences ,the
four major NCDs are linked to preventable lifestyle
risk factors such as an unhealthy diet, lack of physical
activity or poor physical exercise, obesity, and
overweight, smoking, and unsafe alcohol use, all of
which require a plan to reduce (3,4)In Iraq, lifestyle and
eating habits have led to an increase in the number of
non-communicable diseases over the decades, Rapid
increase in the prevalence of some non-communicable
diseases such as cancer, diabetes, respiratory diseases,
and cardiovascular diseases collectively cause half of
the deaths. About a third of these die before reaching
the age of 70 regardless of the gaps in medical care and
the population’s knowledge of non-communicable
diseases (5)
Objectives of this study was to estimate the
prevalence of risk factors of non-communicable in
Basrah / Iraq during 2020-2021.
Material and Methods
The Study design was a cross sectional study was
conducted in Basrah province during the period from
September 2020 to February 2021.
Ethical consideration
Legal permission was obtained from Southern
Technical University, the Ministry of Health, and the
Public Health Department in Basra to conduct the
research.
Study sample
The study included 250 attendants to Basrah
Primary Health Care Centers. Study sampling was
a random sample method. The total sample was
conducted according to the equation of the minimum
size of the sample collected randomly to cover all
parts of Basrah province.
N= P (1-P) (Z/E) 2 (6)
Data Collection
Data collected from interviews of people
who attended the (PHCCs) by Questionnaire was
prepared according to the WHO stepwise survey
for chronic disease, Questionnaire included three-
step to provide information from participants. Step1
include socio-demographic characteristic such as
age group, gender, material state, education level,
residence and employment state. Step 2 includes the
history of chronic disease (cardiovascular disease,
cancer, diabetes mellitus, hypertension, asthma, and
epilepsy). Step 3 include most risk factor contributing
with chronic disease (obesity, salt intake, unhealthy
diet, physical inactivity, and stress) from participant
different parts of Basrah.
Limitation of study
The study was implemented during the COVID-19
pandemic that makes face-face interviews more
difficult. missing in patients with cancer diseases
because fair from infection.
Statistical Analysis
Data of the study were collected and analyzed by
Microsoft Excel 2016, and SPSS version 23to estimate
(mean, ± standard deviation SD, and median) with
frequency and percentage. The coloration between a
variable of data by chi-square test with p.value<0.05.
Results
The founding of the study found the respondent
rate (96%) from 260 respondents, the percentage
of female was138 (55%) and male was112 (45%),
according to age the highest percentage 59 (23.6%)
was found to be among the age group of (50-59)
while lowest percentage 35 (14%), regarding to
 Indian Journal of Forensic Medicine & Toxicology, January-March 2022, Vol. 16, No. 1 1407

marital status the highest percentage was 195 (78%)
in currently married while lowest found to be among
Divorce was 8(3.2%), however, for education level
the highest percentage was 76 (30.4%)found in
not read or write while lowest in postgraduate was
1(0.4%),according to employment status the highest
percentage was found in non-employee 169(67.7%)
while lowest percentage in student 1(0.4%), Over 189
(76%) of the sample was from Basra’s city center. as
shown in Table (1).

Table 1: - The socio-demographic characteristics of the study sample.

Frequency(N)
N Parameter Percent(%)
N=250
1 Age (Mean ±SD with (Median)) in years 44.944±14.82(45)

18-28 35 14

29-39 57 22.8

40-49 56 22.4
2 Age group
50-59 59 23.6

60-69 26 10.4

>70 17 6.8

Male(47.67±14.484 ) 112 44.8

3 gender (Mean±SD)
Female(42.73±14.783) 138 55.2

Single 21 8.4

Married 195 78
4 Marital status
Divorce 8 3.2

Widower 26 10.4

Not read or write 76 30.4

Primary certificate 58 23.2

Intermediate certificate 37 14.8

5 Education level Secondary certificate 27 10.8

Diploma degree 28 11.2

Bachelor’s degree 23 9.2

Post graduate 1 0.4

1408 Indian Journal of Forensic Medicine & Toxicology, January-March 2022, Vol. 16, No. 1

Cont... Table 1: - The socio-demographic characteristics of the study sample.

Employee 58 23.2

Non-employee 169 67.6

6 Employment status
Other 22 8.8

Student 1 0.4

Center of Basrah 189 75.6

Shatt Al-Arab 25 10.0

7 Residence
Al Qurna 1 0.4

Al zubair 35 14.0

The Prevalence of obesity and overweight 95 (38%) and 89 (35.6 %) was more than twice higher in the
study population when compared to overweight 65 (26%) BMI was significantly higher in a female with a mean
of BMI 29.91± 6.04 than the male with a mean of BMI 28.05± 4.66 as shown in table (2)

Table (2) Distribution of overweight and obesity in study sample according to BMI.

Male Female
N Total P.value
BMI (kg\m2)
N % N %

1
1 Underweight 0 0.0% 1 100%
0.4%
65
2 Normal weight 34 52.3% 31 47.7%
26%
89
3 Over weight 48 53.9% 41 46.1%
35.6%
0.016
59
4 Obesity 19 32.2% 40 67.8%
23.6%
25
5 Obesity II 9 36.0% 16 64.0%
10%
11
6 Obesity III 2 18.2% 9 81.8%
4.4%

7 Mean±SD 28.05± 4.66 29.91± 6.04 29.07± 5.53

Pearson Chi-Square test, df=5, n=250

The prevalence of behavioral risk factor was highly
increased in both female and male in the population of
Basrah with a higher percentage of unhealthy diet 211
(84.4%) and the prevalence of salt intake was higher
than recommended by who (10 grams per day) was
207 (82.8%) of study sample while fruit and vegetable
more than 175 (70% )with weekly frequent (less than
five per week) according to fat and sugar intake highly
prevalence of eating food with high fat and sugar
equal to 203 (81.2% )on the other hand decline in fast
food and soft drink to 125(50%) with the quarantine
because of COVID 19 pandemic. The prevalence of a
 Indian Journal of Forensic Medicine & Toxicology, January-March 2022, Vol. 16, No. 1 1409

current smoke was 60(24%) with significantly higher more than one to third of the sample with 184(73.2%)
in males than females. While alcohol consumption suffering from stress issues as presented in table (3).
only 1(0.4%) of the sample study. Regarding stress

Table (3) Distribution of Behavioral risk factor in the study sample

N Parameter Frequency Percentage
Healthy 39 15.6%
1 Diet
Unhealthy 211 84.4%
Yes 207 82.8%
2 Salt intake
No 43 17.2%
I don’t eat 43 17.2%
3 Frequency of salt intake Moderate 157 62.8%
Always 50 20. %
Yes 221 88.4%
4 Fruit& vegetable intake
No 29 11.6%
I don’t eat 28 11.2%
5 Frequency Fruit& vegetable intake Daily 47 18.8. %
Weekly 175 70%
Yes 203 81.2%
6 Fat & sugar intake
No 47 18.8%
Yes 123 49.2%
7 Fast food intake No 125 50 %
I don’t know 2 .8%
Yes 132 52.8%
8 Soft drink consumption
No 118 47.2%
Yes 60 24. %
9 Smoker status
No 190 76. %
Yes 1 .4%
10 Alcohol consumption
No 249 99.6%
Yes 74 29.6%
11 Physical activity status
No 176 70.4%
Low 2 2.7%
12 Type physical activity Moderate 63 85.1%
High 9 12.2%
Yes 184 73.2%
13 Suffering from Stress No 42 16.8%
I don’t know 25 10 %
Nervous 170 84 %
14 Type of Stress
Quite 40 16 %
1410 Indian Journal of Forensic Medicine & Toxicology, January-March 2022, Vol. 16, No. 1

Our study found a highly significant relationship While they are not statistically significant in terms of
between high salt intake, fat and sugar intake, and other variables available (diet, low fruit and vegetable
junk food intake with non-communicable diseases. intake, smoke status, physical inactivity, and stress)
as shown in Table (4).
Table (4): - Relationship between non-communicable diseases and their risk factors in the study sample.
Presences of Non-communicable
diseases
N Subject Yes No Total Df P-value

n % n %

Healthy 25 10.0% 14 5.6% 39

2 Diet 1 0.152
Unhealthy 109 43.6% 102 40.8% 211

Yes 101 40.4% 106 42.4% 207

3 salt intake 1 0.001
No 33 13.2% 10 4.0% 43

Yes 116 46.4% 105 42.0% 221

Fruit& vegetable
4 1 0.331
intake
No 18 7.2% 11 4.4% 29

Yes 104 41.6% 107 42.8% 211

5 Fat & sugar intake 1 0.001
No 30 12.0% 9 3.6% 39

Yes 56 22.4% 67 26.8% 123

6 Fast food intake No 77 30.8% 48 19.2% 125 2 0.036

I don’t know 1 .4% 1 .4% 2

Yes 66 26.4% 66 26.4% 132

Soft drink
7 1 0.220
consumption
No 68 27.2% 50 20.0% 118

Yes 35 14.0% 25 10.0% 60

8 Smoke status 1 0.390
No 99 39.6% 91 36.4% 190

Yes 1 .4% 0 0.0% 1

Alcohol
9 1 0.350
consumption
No 133 53.2% 116 46.4% 249

Yes 37 14.8% 37 14.8% 74

Physical activity
10 1 0.450
status
No 97 38.8% 79 31.6% 176

Yes 101 40.4% 82 32.8% 183

Suffering from
11 No 19 7.6% 23 9.2% 42 2 0.504
Stress
I don’t know 14 5.6% 11 4.4% 25

N=250
 Indian Journal of Forensic Medicine & Toxicology, January-March 2022, Vol. 16, No. 1
Discussion
This study was reported a high prevalence of
self-reported non-communicable diseases among the
population of Basrah and this increase due to highly
increase in risk factors associated with NCDs, a better
understanding of the socio-demographic as shown
in table (1) determinants of disease risk factors in
communities would enable us to identify at-risk
populations that assist in controlling the epidemic of
non-communicable diseases. (7) In most recent studies,
there was a significant association between urbanization
and most marine risk factors such as obesity, lack of
physical activity, and decreased fruit and vegetable
intake, Prevalence of non-communicable diseases,
especially cardiovascular disease, type 2 diabetes,
and hypertension. (8) According to the prevalence of
overweight and obesity our founding higher than a
survey of non-communicable diseases risk factor in
2015(9) and comparable with previous local surveys
in Erbil region and Bagdad (10) and more than in Iran
59.3 % in 2016 (11) and Morocco (35.5 % overweight
\ 20.6 % obesity) but less than the prevalence in
Kuwait (37 % overweight \40.3 %obesity) (12)
and
in Jordan (>75 % overweight \obesity (13)
, according
to physical activity, a recent study demonstrated that
those who was physically inactive are nearly twice
as likely to die as those who exercise. For the time
being, there were worldwide plans to get the physical
inactivity level down to 10 % by the year 2025. (14) the
prevalence of physical inactivity among respondents
higher than in Lebanon was 61.0% and Egypt was
32.1%, Palestine 46.5%. (15,16,17) Because there was no
major program promoting physical activity in Basrah,
more emphasis should be placed on promoting it.
Policies aimed at improving health, Regrinding to
smoke one from four respondents were a currently
smoker and higher than WHO step survey 2015 in
Iraq was 21%(18) and Palestine 20.2%and less than the
prevalence in Lebanon was 38.5% and in similarity
with Egypt 24.4%. (15,16,17) for Alcohol consumption
1411
in similarity with national step survey 2015 was0.6%
because of agriculture of Arab word and Islamic
religion that Promot to avoid Alcohol consumption
(19)
While the prevalence of low fruit and vegetable
intake was less than recommended by those who were
five Servings per day. According to studies, eating
fruits and vegetables in abundance has been shown
to reduce the risk of coronary heart disease, obesity,
and possibly some types of cancer and heart diseases
(20)
so it makes sense to eat the recommended amount
daily, Affordability and accessibility were crucial in
low-and middle-income countries. (21)
Conclusions
The study found that the percentage of non-
communicable diseases was high among the
population of Basrah especially in the elderly, this
increase is attributed to an increase in risk factors due
to social transformation and eating habits without any
effective programs to prevent these risk factors and
control non-communicable diseases.
Ethical Clearance: The Research Ethical
Committee at scientific research by ethical approval
of both MOH and MOHSER in Iraq
Conflict of Interest: None
Funding: Self-funding
References
1- Kim HC, Oh SM. Non communicable diseases:
current status of major modifiable risk factors in
Korea. Journal of preventive medicine and public
health. 2013 Jul;46(4):165.
2- Allen L. Are we facing a non communicable
disease pandemic?. Journal of epidemiology and
global health. 2017 Mar 1;7(1):5-9.
3- Global regional, and national comparative risk
assessment of 84 behavioural, environmental and
occupational, and metabolic risks or clusters of
risks, 1990–2016: a systematic analysis for the
1412 Indian Journal of Forensic Medicine & Toxicology, January-March 2022, Vol. 16, No. 1
Global Burden of Disease Study 2016. Lancet.
2017;390(10100):1345 – 422. https://doi.
org/10.1016/s0140-6736(17)32366-8.
4- Ghasemian A, Ataie-Jafari A, Khatibzadeh S,
Mirarefin M, Jafari L, Nejatinamini S, et al.
National and sub-national burden of chronic
diseases attributable to lifestyle risk factors in
Iran 1990–2013; study protocol. Arch Iran Med.
2014;17(3):146–58.
5- Bhattarai MD. Epidemic of non-communicable
diseases and its control. Kathmandu University
Medical Journal. 2012;10(2):1-3
6- Ogston SA. Adequacy of Sample Size in Health
Studies.
7- Murphy GA, Asiki G, Ekoru K, Nsubuga RN,
Nakiyingi-Miiro J, Young EH, Seeley J, Sandhu
MS, Kamali A. Sociodemographic distribution
of non-communicable disease risk factors in rural
Uganda: a cross-sectional study. International
journal of epidemiology. 2013 Dec 1;42(6):1740-
53
8- Caprara G. Mediterranean-Type Dietary Pattern
and Physical Activity: The Winning Combination
to Counteract the Rising Burden of Non-
Communicable Diseases (NCDs). Nutrients.
2021 Feb;13(2):429.
9- World Health Organization. Noncommunicable
diseases risk factors STEPS Survey, Iraq 2015.
Update. 2015..http://www.who.int/chp/steps/
Iraq_2015_STEPS_Report.pdf?ua=1
10- Shabu, S. Prevalence of overweight/obesity
and associated factors in adults in Erbil,
Iraq: A household survey. Zanco J Med Sci.
2019;23(1):128-134. https://doi.org/10.15218/
zjms.2019.017
11- Djalalinia S, Saeedi Moghaddam S, Sheidaei
A, Rezaei N, Naghibi Iravani SS, Modirian M,
Zokaei H, Yoosefi M, Gohari K, Kousha A, Abdi
Z, Naderimagham S, Soroush AR, Larijani B,
Farzadfar F. Patterns of Obesity and Overweight
in the Iranian Population: Findings of STEPs
2016. Front Endocrinol. 2020 Feb 26;11:42. doi:
10.3389/fendo.2020.00042
12- Weiderpass E, Botteri E, Longenecker JC,
Alkandari A, Al-Wotayan R, Al Duwairi Q,
Tuomilehto J. The prevalence of overweight and
obesity in an adult Kuwaiti population in 2014.
Frontiers in endocrinology. 2019 Jul 9;10:449.
Doi: 10.3389/fendo.2019.00449.
13- Ajlouni K, Khader Y, Batieha A, Jaddou H, El-
Khateeb M. An alarmingly high and increasing
prevalence of obesity in Jordan. Epidemiol
Health. 2020;42:e2020040. doi: 10.4178/epih.
e2020040
14- World Health Organization. Diet, nutrition, and
the prevention of chronic diseases: report of a
joint WHO/FAO expert consultation. World
Health Organization; 2003 Apr 22
15- Mansour Z, Said R, Dbaibo H, Mrad P, Torossian
L, Rady A, Dufouil C. Non-communicable
diseases in Lebanon: results from World Health
Organization STEPS survey 2017. Public Health.
2020 Oct 1;187:120-6.
16- World Health Organization. Non-communicable
diseases risk factors: STEPS survey Egypt 2012.
2012
17- World Health Organization. Non-communicable
diseases risk factors: STEPS survey Palestine
2011. 2011
18- Al-Badri HJ, Khaleefah Ali MA, Ali AA,
Sahib AJ. Socio-economic determinants of
smoking among Iraqi adults: Data from Non-
Communicable Risk Factor STEPS survey 2015.
PLoS One. 2017 Sep 28;12(9):e0184989
19- Probst C, Manthey J, Rehm J. Understanding
the prevalence of lifetime abstinence from
alcohol: An ecological study. Drug and alcohol
dependence. 2017 Sep 1;178:126-9.
20- World Health Organization. Diet, nutrition, and
the prevention of chronic diseases: report of a
joint WHO/FAO expert consultation. World
Health Organization; 2003 Apr 22.
 Indian Journal of Forensic Medicine & Toxicology, January-March 2022, Vol. 16, No. 1 1413

21- Lachat C, Otchere S, Roberfroid D, Abdulai A, prevention of noncommunicable diseases in low-

Seret FM, Milesevic J, Xuereb G, Candeias V, and middle-income countries: a systematic policy
Kolsteren P. Diet and physical activity for the review. PLoS Med. 2013 Jun 11;10(6):e1001465.